Follow-up—an essential step for good medicine

DR QUIROS

By Salvador Quiroz

The older I get, the more I am convinced that the spoken word is a very primitive and sometimes dangerous way for human beings to communicate. When hubby phones his spouse to let her know “I will be a little late for supper” and with dinner usually being at six, she understands he will be arriving around six-thirty or seven, max. So when hubby opens the door a little before ten, you can all imagine what he is in for.

This is an ever-present problem in every doctor’s office. The patient is trying very hard to let the physician know what the complaint or the symptoms of the ailment are. Words like dizziness, tiredness, weakness, oppression, tingling, etc., are used. If the physician is not careful to cross-examine the patient, he is prone to understand something entirely different from what the patient is trying to convey.

He may consequently direct his physical examination, looking for data that is not there, based on his already pre-conceived idea of what the problem is. Tests will also be ordered along that line and the diagnosis may be missed entirely. Also, there are patients who, knowingly or not, indicate to their doctor, “Yes, I have lost more than five pounds in the last two weeks, but, then, I have hardly eaten anything.” This could very well be the end of the story but a deeper analysis would show the loss of weight to be out of proportion to the patient’s explanation and lead the doctor to investigate a possible malignancy.

Situations like this, and many others that we will some day deal with, are a daily occurrence. What I would like to stress is that we are talking about a first interview. The patient leaves the doctor’s office with a prescription and usually with instructions to call back about his progress or to return with the results of the tests ordered. In the best of cases, the patient will comply. But often, when three days have elapsed and there seems to be no improvement, they will quickly decide the doctor was on the wrong track and that another opinion is warranted, thus embarking on the same ordeal for the second time.

Because so many factors may be involved that are responsible for lack of improvement in the patient, it is essential that doctor-patient communication not be broken. A phone call or another visit usually helps to put things on the correct track. Misunderstandings during the first interview, on the part of both the patient and/or the physician may be cleared up and re-orient the diagnosis and the treatment to follow. I recognize all doctors make mistakes, and that there are some physicians better than others, but a rational follow-up allowed by the patient is an essential step toward better medicine.

I have received several phone calls asking whether there is an epidemic going around that is causing headaches, muscle and joint pain, cough, runny nose and fever at the onset. The answer is yes, like every year during late autumn or early winter, we see more patients with what the French call “the gripe,” Mexicans “la gripa” and Americans a “flu-like illness.” It is usually self-contained in three to four days, but their physicians should carefully watch persons with pre-existing respiratory problems.